51 - Stiff Shoulder

Abstract

The stiff shoulder is a commonly encountered diagnostic and therapeutic challenge. An accurate patient history is a key component in establishing a correct diagnosis. Patient demographics, as well as comorbid conditions, play a significant role in evaluating the stiff shoulder. Patients typically present with pain and/or stiffness. Idiopathic shoulder stiffness is often referred to as frozen shoulder or adhesive capsulitis, which are used interchangeably in literature. The pathognomonic physical examination finding to distinguish adhesive capsulitis from other causes of shoulder stiffness is a loss of both active and passive range of motion. Physical exam includes a thorough inspection of the shoulder girdle, the entire upper extremity, neck, and upper thorax. All joints, bony surfaces, and prominences, and soft tissue structures are palpated for tenderness, crepitus, deformity, or any asymmetry. Assessment of motion and strength around the shoulder requires examination of both shoulders in both passive and active motion. Imaging may aid in the diagnosis of idiopathic adhesive capsulitis, but the diagnosis remains largely clinical. Radiographs are mostly helpful in identifying and ruling out other common causes of the stiff shoulder. Treatment is based on disease severity, with mild stiffness and pain amenable to oral antiinflammatory medications, corticosteroid injections, and/or physical therapy. In more advanced or refractory cases, surgical intervention has been successfully used to treat adhesive capsulitis, which may include manipulation under anesthesia or arthroscopic capsular release. Postoperatively, it is important to demonstrate to the patient that full motion was obtained in the operating room and to continue physical therapy postoperatively to preserve regained motion. Reported complication rates from arthroscopic treatment remain low, but inherent risks of infection, subscapularis transection, and neurovascular injury (axillary nerve) still exist.